Organization of the US Health Services System Chapter 4 T L Koehlmoos, PhD, MHA Adjunct Professor HSCI 678 Intro to US Health System

Health Services Organization Central component of the Roemer Model Ministry of Health, Public Health, Private Market USA No centralized Ministry of Health Department of Health and Human Services Regulation and Finance of some healthcare Most personal care in Private Sector

Public Health Public Health = Population Health Emphasizes: Prevention, Promotion, Reporting, Environmental Factors, Collection of Vital Events Although some public health facilities deliver personal care (vaccines, STD, HIV/AIDS), most personal care is in the private sector.

Public Health: Nationally Department of Health and Human Services Cabinet-level position Public Health Service (PHS) CDC, FDA, HRSA, NIH, SAMSHA, AHQR Public Health Service: “To prevent unnecessary disability and disease and to achieve a better quality of life for all Americans”

CDC Centers for Disease Control and Prevention Atlanta, Georgia Birth Defects and Disabilities Chronic Disease and Health Promotion Health Statistics, Global Health Infectious Disease (STD/HIV/TB Prevention) National Immunization Program National Inst for Occupational Safety & Health And much more!

Other Important DHHS Agencies Food and Drug Administration— Food, cosmetics, drug, device safety Health Resources and Services Admins. Development of healthcare workforce National Practitioner Database National Institutes of Health Biomedical Research/ Technology assessments National Library of Medicine

More DHHS Agencies Substance Abuse and Mental Health Services Administration Indian Health Service Agency for Healthcare Research & Quality Cost, Quality and Access Patient Outcome Research Teams Several National Databases CMS-Centers for Medicare and Medicaid Services (formerly HCFA)

State Level Public Health Vary widely from state to state Funded by State and by federal block grants Most likely to focus on: Vital Statistics Public Health Education Environmental Sanitation Public Health Laboratories Prevention & Control of Communicable Disease MCH (if no other available)

Local Level Public Health City, county, multi-city or –county Wide variations Common functions: Assess and monitor local health problems Provide policy and leadership Ensure high quality services Protection of public health at the local level Various means of financial support

Other Ministry Level Health Functions Department of Defense Department of Veterans Affairs Department of Justice Drug Enforcement Agency Department of Agriculture (WIC) Department of Labor Environmental Protection Agency

Voluntary Agencies Disease Specific Population Specific March of Dimes, ACS, AHA Population Specific AARP, Children’s Defense Fund Red Cross Professional Associations--AMA Philanthropic Foundations--RWJohnson Religious Groups

Enterprises in US Healthcare Enterprises: health functions sponsored by non-health businesses Occupational Health Clinics Fitness Centers at work Substance Abuse programs at work

The Private Market In US most healthcare delivered in private sector Medical Equipment and Devices Pharmaceuticals and supplies (10% of US total healthcare expenditures) Health Insurance Training the Workforce (Public/Private)

Conclusion The US Healthcare System is complex and decentralized DHHS is the equivalent of a Ministry of Health in the Roemer Model Combination of national, state and local public health services Private Market is responsible for the delivery and production of most care in the US